What lies beneath? A lesson for the clinician. Intraoperative frozen section appearance of persistent basal cell carcinoma after apparent cure with imiquimod 5% cream.

The Food and Drug Administration (FDA) has approved imiquimod 5% cream for the treatment of nonfacial superficial basal cell carcinoma (BCC), and it has increased in popularity as a nonsurgical approach for the treatment of BCC. Its use for the treatment of superficial BCCs on the trunk, neck, and extremities has been documented in the dermatology and family physician literature. Studies of imiquimod for nodular BCC, on the other hand, have demonstrated suboptimal cure rates according to both clinical and histologic criteria, but little is known about the efficacy of imiquimod cream in the treatment of more extensive lesions, more aggressive BCC subtypes, or treatment in higher risk locations like the face, although the off-label practice of treating facial BCCs with imiquimod is not rare.